Norman parathyroid

BACKGROUND: Living kidney donation offers a unique setting to study changes in phosphate and vitamin D homeostasis attributable to mild isolated decreases in estimated glomerular filtration rate (eGFR). STUDY DESIGN: Cross-sectional study. SETTING & PARTICIPANTS: 198 living kidney donors and 98 nondonor controls from 9 transplant centers across 3 countries. For donors, median time after donation was 5.3 years. At assessment, donors had a lower eGFR than controls (73 vs 98 mL/min/1...

BACKGROUND: Cinacalcet (Sensipar) has been shown to decrease calcium levels in patients with primary hyperparathyroidism (PHPT); however, few other endpoints have been studied and long-term effects are not known. METHODS: At the discretion of a referring doctor, 70 patients began Cinacalcet as an alternative to surgery for PHPT. Patients were followed as long as the drug was tolerated at which time all underwent parathyroidectomy. RESULTS: Before treatment, serum calcium levels averaged 11...

The 20 per cent rule proposed by Norman established a guideline using radioactivity in the minimally invasive radioguided parathyroidectomy (MIRP) technique to localize and confirm removal of an abnormal parathyroid gland in patients with primary hyperparathyroidism. If radioactivity in the resected gland was at least 20 per cent of excision site/background radioactivity, the 20 per cent rule was satisfied. Patients meeting these criteria underwent unilateral MIRP without intraoperative parathyroid hormone assay or intraoperative frozen section...

OBJECTIVE: It has been taught that a missing parathyroid adenoma can be within the thyroid. Therefore, thyroid lobectomy is appropriate when an adenoma cannot be found. Unfortunately, this technique is often futile. The purpose of this study is to examine the frequency of unsuccessful thyroid lobectomy in parathyroid surgery and to look at the true incidence and location of intrathyroid parathyroid adenomas (iT-PAs). STUDY DESIGN: A retrospective chart review of 11,163 patients undergoing parathyroid surgery identifying the location of more than 40,000 parathyroid glands...

OBJECTIVE: To better define the typical and atypical biochemical profiles of patients with surgically proven primary hyperparathyroidism. METHODS: In this single-center, prospectively conducted study of consecutive patients with surgically proven primary hyperparathyroidism over a 7-year period, we analyzed serum calcium, parathyroid hormone, and 25-hydroxyvitamin D concentrations. RESULTS: A total of 10 000 patients were included, and more than 210 000 calcium, parathyroid hormone, and 25-hydroxyvitamin D values were evaluated...

BACKGROUND: Although localizing studies are well-known predictors of which patients are candidates for unilateral versus bilateral parathyroid exploration, there are a number of other factors that have positive or negative influence preoperatively and intraoperatively. STUDY DESIGN: A prospective study was conducted during 20 months on 3,000 consecutive patients undergoing surgery for primary hyperparathyroidism to determine which factors caused the surgeons to explore bilaterally or, in contrast, influenced a unilateral approach...

BACKGROUND: To determine the amount and duration of supplemental oral calcium for patients with varying clinical presentations discharged immediately after surgery for primary hyperparathyroidism. STUDY DESIGN: A 4-year, prospective, single-institution study of 6,000 patients undergoing parathyroidectomy for primary hyperparathyroidism and discharged within 2.5 hours. Based on our previous studies, patients are started on a sliding scale of oral calcium determined by a number of preoperative measures (ie, serum calcium, body weight, osteoporosis) beginning 3 hours postoperation and decreasing to a maintenance dose by week 3...

BACKGROUND: Determining the physiologic activity (hormone production) of individual parathyroid glands can provide tremendous guidance during parathyroidectomy. METHODS: A 6.5-year prospective study of 5,000 patients with sporadic, non-multiple endocrime neoplasia (MEN) primary hyperparathyroidism who underwent surgery without frozen section or parathyroid hormone (PTH) assays was conducted. Patients who had a frozen section were not included; the removal of parathyroid glands was determined solely by the physiologic activity of each gland as determined by contained radioactivity...

OBJECTIVES: To reexamine the "Norman rule" (affected parathyroid gland would contain at least 20% radioactivity compared with background), report normative radiation data, offer alternative ratios, and explore the effect of lapsed time on minimally invasive parathyroidectomy (MIRP). DESIGN: Retrospective analysis. SETTING: Tertiary care academic medical center. PATIENTS: A total of 116 consecutive patients who had a diagnosis of primary hyperparathyroidism, positive findings on sestamibi scan, and complete study data from 2000 to 2005 at a single institution...

OBJECTIVE: Sialolithiasis is a frequent condition seen and treated by otolaryngologists. Salivary stones typically affect the submandibular and parotid glands and can arise from electrolyte disturbances, stasis, or a chronic infectious origin. Primary hyperparathyroidism (pHPT) is associated with 'stone disease', but this has been universally considered to refer to kidney stones. Few case reports exist reporting the relationship between pHPT and sialolithiasis. DESIGN: A retrospective patient series from a single surgical practice...

AIM: Determining the physiologic activity (hormone production) of individual parathyroid glands by measuring their contained radioactivity is extremely accurate and provides tremendous guidance during parathyroidectomy. METHODS: A single-surgeon's experience with over 8,000 radioguided parathyroidectomies, 7,500 of which were for primary, sporadic, non-MEN hyperparathyroidism (HPT). All operations were within 2.25 hours of sestamibi scanning. Ex-vivo measures of parathyroid glands, thyroid nodules, lymph nodes, thymus, and fat were obtained from all patients, constituting over 42,000 specimens...

New knowledge of the biological and clinical importance of the steroid hormone 1alpha,25-dihydroxyvitamin D(3) [1alpha,25(OH)(2)D(3)] and its receptor, the vitamin D receptor (VDR), has resulted in significant contributions to good bone health. However, worldwide reports have highlighted a variety of vitamin D insufficiency and deficiency diseases. Despite many publications and scientific meetings reporting advances in vitamin D science, a disturbing realization is growing that the newer scientific and clinical knowledge is not being translated into better human health...

OBJECTIVE: To determine whether fine-needle aspiration (FNA) of parathyroid adenomas may cause a severe fibrotic reaction of the gland and surrounding structures, making surgery more difficult and histology more confusing. DESIGN: A study was conducted over a 33-month period to compare the operative findings of 30 patients who underwent FNA of a parathyroid adenoma to those of 3000 patients who had not had their parathyroid tumor aspirated. Each patient's normal parathyroid glands also served as internal controls...

Parathyroid cysts are much less common than other cystic lesions of the neck. The great majority of parathyroid cysts are endocrine non-functioning. Parathyroid cysts may become symptomatic because of hormonal activity or due to the size and pressure effects. This is a case history of a 43 year-old woman, who presented with dyspnea. A 9 + 8 + 6cm cervical-mediastinal parathyroid cyst causing dyspnea, dysphagia, respiratory failure and jugular vein thrombosis was found.

OBJECTIVE: To evaluate the safety of immediate discharge after parathyroidectomy and to establish a protocol for the amount and duration of supplemental orally administered calcium for patients with varied clinical presentations of primary hyperparathyroidism. METHODS: A 40-months, prospective, single institution, cohort study of 3,000 consecutive patients undergoing parathyroidectomy and discharged within 2.5 hours after the operation is reviewed. The amount of oral calcium supplementation prescribed postoperatively varied according to a protocol that considered the degree of serum calcium elevation preoperatively as well as the intraoperative findings (hyperplasia versus adenoma)...

OBJECTIVE: Parathyroid surgery in elderly patients is commonly delayed due to perceived high operative risk. We evaluated the presentation of patients over 80 with primary hyperparathyroidism (PHPT) and their ability to tolerate outpatient, minimally invasive parathyroidectomy. METHODS: We conducted a prospective cohort study of 150 consecutive patients over the age of 80 for the treatment of sporadic, nonfamilial PHPT. Presenting symptoms were compiled by questionnaire and compared between male and female (32 males, 118 females) and to 2600 patients under the age of 80...

OBJECTIVE: This prospective study examined rapid patient discharge after routine parathyroidectomy to identify differences between morbidly obese and non-morbidly obese patients. The efficacy of supplemental calcium in preventing postoperative hypocalcemia was also assessed. METHODS: Between March 2003 and June 2004, 842 patients with primary hyperparathyroidism underwent outpatient parathyroid surgery. Morbid obesity was defined as 100 pounds above ideal body weight and/or body mass index greater than 39...

BACKGROUND: Intermittent dosing of calcitriol for secondary hyperparathyroidism (SHPT) has been associated with greater parathyroid hormone (PTH) reduction with fewer calcemic and phosphatemic effects than daily (QD) dosing. METHODS: Secondary analyses of three randomized, double-blind, placebo-controlled multicenter studies in stage 3 and 4 chronic kidney disease (CKD) patients with SHPT were performed to compare three times per week (TIW) with QD dosing of paricalcitol...

BACKGROUND: This randomized clinical trial is designed to assess whether the prevention and/or correction of anemia, by immediate versus delayed treatment with erythropoietin alfa in patients with chronic kidney disease, would delay left ventricular (LV) growth. Study design and sample size calculations were based on previously published Canadian data. METHODS: One hundred seventy-two patients were randomly assigned. The treatment group received therapy with erythropoietin alfa subcutaneously to maintain or achieve hemoglobin (Hgb) level targets of 12...

Phosphoenolpyruvate carboxykinase (PEPCK) catalyzes a rate-limiting step in hepatic and renal gluconeogenesis. In the kidney, PEPCK expression is enhanced during metabolic acidosis and in response to ANG II and parathyroid hormone. The effect of the latter hormone is mediated, in part, by cAMP. Treatment of subconfluent cultures of LLC-PK1-F+ cells, a gluconeogenic line of porcine proximal tubule-like cells, with cAMP produces a pronounced increase in the level of PEPCK mRNA. The luciferase activity of pLuc/3'-PCK-1, a reporter construct that contains the 3'-UTR of the PEPCK mRNA, was increased three- to fourfold by coexpression of the catalytic subunit of protein kinase A (PKA)...